Once in dental hygiene school, you are all of a sudden allowed to buy sharp tiny weapons and insert them into your classmates gum line. The next semester you can do this on family and friends and it’s terrifying but awesome! On the plus side they give us 3 full hours to do so. But I downright melted to the ground when they said we would eventually have to condense this to 1 hour.
If I could go back now and talk to my “hygiene student stressed out self”, I would first go over everything we are required to do in school. Just think about it, we have to:
- Go through medical history in depth and usually have to write down what each medication is for in order to prove your knowledge
- Go through the assessments and initial examinations as if this were a new patient, palpating every centimeter of their head and neck
- Check in with your pod professor after all your assessments in which case you may have to wait for them to finish up with someone else and you have to wait for them to review your findings as well
- Once you are finally okayed to start the cleaning, you may have to check in once again when each quad or arch is done just so the professor can sit and feel up all the mesials and distals of your patient’s dentition
- After your patient is all cleaned up, you may have to present some patient education with visual aids included as if your presenting a damn business plan!
- After polishing, you may have to use some disclosing solution in order to make sure your patient has red lips before returning back to work
- Finally we can have the doctor come over and conduct the exam while you recite all the present restorations in your patient’s mouth
- As if you haven’t seen your pod professor enough, make sure they check your notes while the other pod professors with less students shut the clinic’s lights off and rush everyone out
I would then ask my past self if I really expect to do all of this during an actual appointment at private practice. The reality of working in private practice is that you are the clinician. You are responsible for what the patient actually needs and keeping their charts up to date. The doctors come in for a short examination usually about 5 minutes long, unless they’re talkers, then expect to give the doctor the stare down while pointing at your watch.
You won’t have any professors to check in with or limitations to when you can start your treatment. Your medical history and assessments will also be a lot quicker as well. If you are seeing a longstanding patient, odds are their medical history and medications are mostly up to date and you may only have to make small changes every so often.
Perio-charting and x-rays will only be done once per year and hopefully staggered so you are not doing both in one appointment. Perio-charting a longstanding patient will also most likely be an update of numbers and so you may not need to start from scratch. Patient education can be done while you clean the patient’s teeth.
You are the clinician
The biggest point to remember is that if the patient’s teeth are so dirty that they require more than an hour, chances are they need cleanings more often than twice per year or they may need a different service like a general debridement or quad scaling. Patients who come twice a year should not have tenacious calculus or pockets categorizing them in periodontal disease classes. Of course the’re are outliers and rapid formers of plaque, as well as medications that may increase calcification of tartar but again these patients may benefit form one more cleaning per year.
Notes are always the last priority on our list when treating a patient. We push it to the side and figure we can use some of our lunch time or do it at the end of the day, I don’t think we should deprive ourselves from our breaks and should chip some time off of each appointment to at least start them. Here are a couple ways you can fit your notes in:
- When the doctor is talking to the patient or conducting the exam
- When you call the doctor, come back in and start your notes until the doctor arrives
- Before the appointment start the notes and just fill in specifics when you are cleaning up
- After all the assessments, tell the patient you are going to jot down some notes and review their assessments, you can even take this time to make their next appointment as well
Going from 3 hours to 1 is not impossible. We all do it and you will be able to as well! Getting into a consistent routine for your appointments is very important to establish right away. I initially wrote myself a nice check list to glance over at during my appointments. It helped to keep me on task and make sure I was not forgetting any steps especially since no one was watching over my shoulder anymore. You are competent and you got this!